Prognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients. (March 2017)

• Record Type: Journal Article
• Authors: Riva, Emma; Colombo, Riccardo; Moreo, Guido; Mandelli, Sara; Franchi, Carlotta; Pasina, Luca; Tettamanti, Mauro; Lucca, Ugo; Mannucci, Pier Mannuccio; Nobili, Alessandro
• Is Part Of: Archives of gerontology and geriatrics. Volume 69(2017)
• Page Start: 21
• Page End: 30
• Publication Date: 2017-03
• Subjects: Older in-patients -- Anaemia -- Clinical outcomes; Aging -- Periodicals; Geriatrics -- Periodicals; Gerontology -- Periodicals; Electronic journals; 305.26
• DOI: 10.1016/j.archger.2016.11.005
• Languages: English
• ISSNs: 0167-4943

Abstract

Highlights: In older people anaemia contributes to higher mortality and hospitalisation. This multicentre study investigates in 2678 in-patients impact of anaemia on major clinical outcomes. Mild anaemia in older in-patients is a strong predictor of hospital readmission. The types of anaemia affect the risk of mortality from hospital discharge. The worst prognosis is associated with normocytic and macrocytic anaemias. Abstract: Study objective: This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge. Methods: A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0–11.9 g/dL in women; 10.0–12.9 g/dL in men) and group 3 with moderately-severely reduced Hb (<10 g/dL in women and men). Results: Patients (2678; mean age 79.2 ± 7.4 y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR = 1.62; 95%CI 1.21–2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR = 1.82;95%CI 1.25–2.67; group 3: OR = 2.78;95%CI 1.82–4.26) and discharge (group 2: OR = 2.37;95%CI 1.48–3.93; group 3: OR = 3.70;95%CI 2.14–6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes. Conclusions: Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia.